Deparment of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States.
Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States.
Epilepsy Behav. 2021 Jun;119:107958. doi: 10.1016/j.yebeh.2021.107958. Epub 2021 Apr 21.
To determine the suitability of the Aberrant Behavior Checklist (ABC)-a common measure used in clinical trials for treatment of challenging behaviors of autism-as an outcome measure for pharmacological and behavioral interventions for young people with Developmental and Epileptic Encephalopathies (DEEs).
We assessed score profiles on the ABC in a sample of 122 young people with DEEs, including Dravet and Lennox-Gastaut syndromes, and KCNQ2- SCN2A-, and KCNB1-associated disorders. Then we examined its internal structure using item cluster analysis. We used both unrestricted item cluster analysis to determine the number of item clusters that maximize reliability and restricted analyses in which we pre-specified models with 5-, 6-, and 7-clusters, to examine consistency with previous factor analytic studies. We also conducted validity analysis on the various scoring methods with age, sex, and autism spectrum screening measure scores.
Unrestricted item cluster analysis suggested that three clusters maximized reliability of ABC scores. These broadly represented other-directed behaviors (i.e., "externalizing"), self-directed behaviors (i.e., "internalizing"), and inappropriate speech. Restricted models separated item clusters for stereotypy from other self-directed problem behaviors, and self-injurious behaviors from the other externalizing behaviors. Validity analysis also supported these structures. Overall, all scores were low, and less than 20% of DEE participants had symptoms severe enough to qualify for most randomized trials of behavioral therapies.
These results are broadly consistent with the extant ABC scoring algorithms. They suggest a high internal consistency reliability, which may support the use of the ABC in future clinical trials in patients with DEEs who exhibit the behaviors assessed by the ABC. Alternatively, concerns about overall low scores raise cautions about using the ABC as a measure of behavior in unselected populations with DEE.
确定异常行为检查表（ABC）——一种常用于自闭症治疗挑战性行为的临床试验中的常见衡量标准——是否适合作为发育性和癫痫性脑病（DEE）患者药物和行为干预的结果衡量标准。
我们评估了 122 名患有 DEE 的年轻人（包括 Dravet 和 Lennox-Gastaut 综合征、KCNQ2-SCN2A-和 KCNB1 相关疾病）的 ABC 评分模式。然后，我们使用项目聚类分析评估其内部结构。我们使用无限制项目聚类分析来确定最大程度提高可靠性的项目聚类数量，以及限制分析，其中我们预先指定了 5、6 和 7 个聚类的模型，以检查与之前的因素分析研究的一致性。我们还对各种评分方法进行了有效性分析，包括年龄、性别和自闭症谱系筛查测量评分。
无限制项目聚类分析表明，三个聚类可以最大程度地提高 ABC 评分的可靠性。这些聚类大致代表了指向他人的行为（即“外化”）、指向自身的行为（即“内化”）和不适当的言语。受限模型将刻板行为与其他自我导向的问题行为以及自伤行为从其他外化行为中分离出来。有效性分析也支持了这些结构。总体而言，所有评分都较低，不到 20%的 DEE 参与者有足够严重的症状，符合大多数行为疗法的随机试验条件。
这些结果与现有的 ABC 评分算法基本一致。它们表明了较高的内部一致性可靠性，这可能支持在未来患有 DEE 且表现出 ABC 评估行为的患者的临床试验中使用 ABC。或者，对总体评分较低的担忧引起了在未选择的 DEE 人群中使用 ABC 作为行为衡量标准的谨慎态度。
